Medical
therapy with
dopamine agonist is very effective in controlling
prolactin serum levels and it usually represents the first therapeutic choice for
prolactin secreting pituitary adenomas. However, many patients present increase of prolactinemia after withdrawal of medical
therapy which consequently should be taken for long time; other present intolerance to medical
therapy; women with pregnancy need to withdraw
dopamine agonists with consequent potential related problems: in these patients transsphenoidal surgery can be requested. The presented study concerns the efficacy of transsphenoidal surgery in patients affected by
microprolactinoma after treatment with medical
therapy for different periods of time. Different postsurgical results were achieved in 2 groups of 24 (group 1) and 25 (group 2) patients affected by
microprolactinoma who had taken medical
therapy for a period of time respectively longer or shorter than 1 year. In summary, the authors observed in group 1 a rate of hormonal remission of 33.3% and an overall prolactinemia improvement with possibility of medical
therapy withdrawal in 49.9% of patients. In group 2, the authors observed a rate of hormonal remission of 84% and an overall rate of improvement with no necessity of medical
therapy of 92%. Therefore, the authors' experience showed that the surgical option for the
therapy of
microprolactinomas should be indicated within 1 year from the beginning of medical
therapy with
dopamine agonist, to achieve a high rate of hormonal remission and possibility to withdraw medical
therapy. The authors' protocol for
microprolactinoma treatment is presented.